S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note.

Abstract

S2 alar-iliac (S2AI) screws are generally placed using an open approach, but have recently been shown to be implantable using a minimally invasive approach. Nevertheless, optimal screw positioning, even when supported by fluoroscopic guidance, is challenging in the complex anatomy of the sacral-pelvic area. This work presents our novel technique of S2AI sacropelvic fixation procedures performed with robotic guidance. This was a single-center, retrospective, mini case-series of adult spinal deformity patients in need of sacropelvic fixation as part of a longer thoraco-lumbar fusion. The surgeon drilled a pilot hole through a robotic guide and then inserted a K-wire. A Jamshidi needle was placed over the K-wire and used to advance the pilot hole anterolaterally. Medical charts of four 60-70year-old patients, who underwent robotic-guided insertion of S2AI screws in a minimally invasive approach were reviewed. Follow-up ranged between 10 and 13months. Post-operative CTs and X-rays showed all eight trajectories were fully within the bone and accurately placed. Average surgery time per patient was 13min with 5.3s of fluoroscopy per screw. No intra- or post-operative complications occurred. Robotic-guidance with a Jamshidi needle technique was a safe and effective means for implanting S2AI screws in a minimally invasive approach.